How do I take an optimal X-ray for an analysis?
The road to an optimal x-ray for analysis
As with any other image analysis, it is important to quality assure that the image contains as much information as possible. Boneprox analysis tool work in the same way to analyze digital x-rays. Therefore, when uploading a picture in the Boneprox portal for analysis, it is important that projection, angle, and exposure are consistent with the guidelines given below. The method is based on the quality of the X-ray, a quality standard that can be used to make various diagnoses. To see if the images are good enough, you can look at them on a histogram scale and see if they are within the approved range for a good image. Exposure time and area are important factors for an optimal image.
One of the dentists’ most important diagnostic tools is the X-ray image. Good knowledge is crucial for safe diagnostics.
The development in X-ray technology has been rapid in recent years. The digital technology is used by a vast majority, but the transition from analog to digital technology has led to some challenges. This is especially true when using sensors that are more difficult to place than the analog images. But it has also increased the possibilities for quick and safe diagnostics. Volume tomography or CBCT, conebeam computed tomography, has also become more accessible, both in specialist clinics and in private dentistry. Thus, there are several research methods to choose from and the opportunity to get much more information from the examination. Hence, there is also a need for more knowledge about how to optimize the X-ray technique.
It is easy to focus solely on the teeth and overlook the condition of, for example, other parts of the jawbone. Dentists are also responsible for the changes that are outside the area we want to study prior to a treatment.
When the image plate and sensor were inserted into the dental care, it meant that it was faster to obtain the X-ray images than when film was used. But as with all new technology there are both advantages and disadvantages, so also when it comes to sensor and image plates.
• The sensor can use shorter exposure time than image plates and film. The disadvantage is that it can be difficult to place the sensor so that the image of teeth and tissues becomes optimal in the diagnosis.
• The image plate has the same detector surface as a film, that is, larger than the sensor surface of the sensor. It is also less sensitive to exposure variations, which among other things means that it is possible to get a good picture of both fixtures and the thin marginal bone despite large density differences.
• Common advantages of the two techniques are that the images can be enlarged and processed, for example, the contrast and light conditions in the image can be changed, which facilitates the diagnostics. When the contrast is increased, structures and pathology can appear more clearly and when it is reduced, one can see, for example, bone marrows that grow into the alveoli.
An important question in diagnostics is: What do I want to know? Next question: How do I find out? The foundation is usually intraoral images in different projections. Is it perhaps necessary to use panoramic X-ray or CBCT X-rays to obtain the information?
• Panorama X-ray provides good overview. It is easy and quick to take the pictures, but they can be difficult to interpret because different structures are projected over each other. The images also do not provide good detail information and often need to be supplemented with intraoral images or CBCT.
• Panorama X-ray is good for seeing changes that are too large to detect on small images, such as cysts and tumors or if there is no need for permanent teeth in children.
• A good aid to assess bone height prior to extensive implant treatment, even if the bone width or quality cannot be assessed, and in cases where the patient has pronounced swallowing reflexes or has difficulty opening the mouth sufficiently to be able to do an intraoral X-ray examination.
• Good for diagnostic assessment of wisdom teeth in the lower jaw before a surgical procedure, although this also gives an overview picture and often needs to be supplemented with intraoral images or CBCT.
• A good educational tool; one can show the patient how the oral status looks. Based on the information in the picture, the dentist can then determine whether additional X-ray images need to be taken to obtain detailed information.
• A problem that occasionally appears is that the air gap between the tongue and the groom obscures the area you want to get information about. An easy way to improve diagnosis in the upper jaw is to ask the patient to hold the tongue up in the groin.
When insufficient information can be obtained from another X-ray, CBCT can be the next step. The CBCT technology provides sharp images in a small area, in addition to 3D. The shape of the alveolar discharge, important in implant treatments, appears clearly as well as root anatomy and any apical periodontitis. Particularly valuable is the technique in the upper jaw molar area where intraoral images are often difficult to interpret.
The radiation dose is higher than in the other X-ray techniques and the regulations requires that a specialist dentist in odontological radiology has the responsibility to ensure that the examinations are justified and optimized as it is called. There should also be a responsible radiation protection physician attached to the business.
The images provide a lot of information and it requires the habit of reviewing the images. Here, too, structures that are found outside the jaws, such as the sinuses, the nasal clusters or the clavicle, are imaged depending on the field size.
It is a technique that will become more common in dental care in the future, because it depicts hard tissue so well and usually it is teeth and jawbones that are most interesting for us dentists,
Which factors / factors can be set?
• Strength of pipe stream (mA)
• Voltage (kV number)
• Exposure time (S)
For instance, to take a good picture for trabecular structure analysis, one should not be too high in time.
The values also depend on the clinic’s make on X-ray apparatus and sensor / imaging plate.
Most have default settings for premolars and bitewing and then you can reduce the time.
Over and Underexposure
It is important that the image is calibrated and taken according to “example” on the page where you upload the analysis. This is because the analysis tool is sensitive to over and underexposure.
If the image is overexposed, this may result in a lower value, and if the image is underexposed, this may affect the value to the higher. See also the example below.
Should you find what you are looking for, you need a good picture. The trabecula structure must be analyzed in the correct range, between 4 and 5, and the sensor should be placed parallel to the mandible.
Slow down the sensor until a perpendicular plane is reached. The image should always be perpendicular. A straightener can be used to facilitate.